CMS Contracts With Additional Claim Reviewer

CMS recently announced that StrategicHealthSolutions has become a supplemental medical review/specialty contractor (SMRC) to “perform and/or provide support for a variety of tasks aimed at lowering the improper payment rates and increasing efficiencies of the medical review functions of the Medicare and Medicaid programs.”

One of the SMRC’s primary tasks will be to conduct a nationwide medical review on Medicare Part A, Part B, and DME providers and suppliers. The SRMC will evaluate medical records and related documents to determine whether Medicare claims were billed in compliance with coverage, coding, payment, and billing practices. In accordance with Section 1833 of the Social Security Act, providers must supply documentation upon request.

The SRMC will notify CMS of any identified improper payments and noncompliance with documentation requests. The Medicare Administrative Contractor (MAC) may initiate claim adjustments and/or overpayment recoupment actions through the standard overpayment recovery process. For more information, contact AAHomecare’s Kim Brummett at (202)372-0750, or visit aahomecare.org.